{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"K ANAYTATAVEYAMRU","gend":1,"add":"    C TPA TC YBSOM C 8452                         ","city":"HARRISONBURG             ","state":"VA","zip":"22801-9998","dob":"1947-08-13","age":"","mstatus":"","insh":"00111559","cliId":"","pno":"3404505713","cno":5402368484,"email":"","ename":"","eno":"","pphy":"QUINN, STACY","ppno":5405647300,"pcpadd":"1661 S MAIN ST,","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":228012728,"pcpcounty":"","pcpid":"","pcpname":"RMH MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"2548 C MOSBY CT APT C                             ","madd2":"                                                  ","madd3":"","mcity":"HARRISONBURG             ","mstate":"VA","mzip":"22801-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K80.20","R10.11","M48.062","E11.3411","M48.061","M51.26","M54.16","I51.7","R07.9","R06.09","I50.9","J81.1","R79.1","I08.0","R00.1","I49.1","Z09","E11.65","I10","E11.3491","D64.9","I11.0","I50.32","I42.9","E78.5","I34.0","E53.8","M19.91","I50.30","I25.9","I27.20","I25.10","R07.89","R06.00","I13.0","E11.22","N18.2","E66.9","Z68.32","E55.9","Z79.82","Z79.51","Z79.84","Z79.899","D50.8","M51.36","G89.29","H40.1112","H40.1121","E11.9","D50.9","R71.0","E11.3292","Z23","R39.11","M51.16","M51.27","M51.17","Z88.5","M54.17","Z95.1","I35.1","J98.4","R06.02","R61","E11.59","I20.8","I49.9","R53.83","Z79.4","Z91.81","Z20.828","D51.0","Z98.890","E11.3493","D51.9","K90.9","G45.9","R29.810","G51.39","M62.838","M62.830","E83.42","Z98.42","Z96.1","R79.0","I11.9","N18.31","D63.1"," "],"date":["2022-01-05","2022-01-05","2022-02-02","2020-10-29","2021-01-29","2021-11-16","2022-02-22","2021-11-20","2021-11-26","2020-02-03","2022-08-17","2020-02-03","2020-02-03","2020-02-04","2021-12-10","2020-02-04","2021-11-26","2020-03-09","2022-10-24","2021-09-15","2022-08-18","2022-02-22","2020-03-19","2020-03-10","2022-10-24","2021-11-19","2022-11-09","2021-04-07","2020-03-09","2020-03-10","2021-11-19","2022-10-24","2021-11-19","2020-03-19","2022-08-17","2022-08-17","2020-03-19","2021-11-20","2020-03-19","2022-02-22","2022-02-22","2020-03-19","2022-02-22","2022-02-22","2022-08-18","2021-04-07","2021-04-07","2022-09-30","2022-09-30","2022-02-22","2022-08-17","2020-07-10","2020-10-29","2022-10-24","2020-10-02","2022-02-22","2021-11-16","2022-02-22","2022-02-22","2022-02-22","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2022-10-24","2021-11-20","2021-11-20","2021-11-20","2021-11-20","2022-10-24","2020-12-01","2021-12-15","2021-12-16","2022-02-03","2022-08-17","2022-02-17","2022-02-21","2022-02-21","2022-03-07","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-03-10","2022-02-21","2022-08-18","2022-08-17","2022-11-09"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68180021709","LOSARTAN\/HCT","TAB 100-25","90","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","540","Select","Select",""],["","65702040810","ACCU-CHEK","TES AVIVA PL","100","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","90","Select","Select",""],["","68382002210","ATENOLOL","TAB 25MG","90","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","100","Select","Select",""],["","00093727398","PIOGLITAZONE","TAB 45MG","90","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","60","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","67877056310","METFORMIN","TAB 1000MG","180","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","28","Select","Select",""],["","70377000415","SIMVASTATIN","TAB 40MG","90","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","68382065005","ISOSORB","TAB 30MG ER","30","Select","Select",""],["","68180051901","LISINOP\/HCTZ","TAB 20-12.5","180","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","59267102504","PFIZER","INJ ADLT RTU","0.30","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","50383023310","DORZOL\/TIMOL","SOL 22.3-6.8","10","Select","Select",""],["","61314014415","BRIMONIDINE","SOL 0.0015","15","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","2","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","99073070805","FREESTYLE    KIT LITE","KIT LITE","1","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","270.00","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","180","Select","Select",""],["","68180030360","CEFUROXIME","TAB 500MG","14","Select","Select",""],["","49281012165","FLUZONE","INJ 2021-22","0.7","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}